<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">


    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><span style="color: red;font-size: 15px">*</span>{:__('头像')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-image" class="form-control" data-rule="required" size="50" name="row[image]" type="text" value="{$row.image|htmlentities}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-image" class="btn btn-danger faupload" data-input-id="c-image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-image" class="btn btn-primary fachoose" data-input-id="c-image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-image"></ul>
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><span style="color: red;font-size: 15px">*</span>{:__('姓名')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control" data-rule="required" name="row[name]" type="text" value="{$row.name|htmlentities}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><span style="color: red;font-size: 15px">*</span>{:__('手机号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" data-rule="required" name="row[phone]" type="text" value="{$row.phone|htmlentities}">
        </div>
    </div>


    <div class="form-group">
        <label for="c-pid" class="control-label col-xs-12 col-sm-2"><span style="color: red;font-size: 15px">*</span>{:__('医护类型')}:</label>
        <div class="col-xs-12 col-sm-8">
            <select id="c-pid" data-rule="required" class="form-control selectpicker" disabled="disabled" name="row[type]">
                <option data-type="type" value="专家" {if condition="$row.type=='专家'"} selected {/if}>专家</option>
                <option data-type="type" value="护士" {if condition="$row.type=='护士'"} selected {/if} >护士</option>
            </select>
        </div>
    </div>


    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><span style="color: red;font-size: 15px">*</span>{:__('账号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-username" class="form-control" data-rule="required" name="row[username]" type="text" value="{$row.username|htmlentities}">
        </div>
    </div>


    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2"><span style="color: red;font-size: 15px">*</span>{:__('密码')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-password" class="form-control" data-rule="required" name="row[password]" type="password" value="{$row.password|htmlentities}">
        </div>
    </div>


    <div class="form-group">
        <label for="c-pid" class="control-label col-xs-12 col-sm-2"><span style="color: red;font-size: 15px">*</span>{:__('状态')}:</label>
        <div class="col-xs-12 col-sm-8">
            <select id="c-status" data-rule="required" class="form-control selectpicker" name="row[status]">
                <option data-type="status" value="1"  {if condition="$row.status=='1'"} selected {/if}>开启</option>
                <option data-type="status" value="0"  {if condition="$row.status=='0'"} selected {/if}>关闭</option>
            </select>
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
